Gastrointestinal neuroendocrine tumors arise from cells of the diffuse neuroendocrine system and can take place almost anywhere within the gastrointestinal tract. A 40-year-old man admitted to evaluate a duodenal subepithelial lesion which was incidentally found at health check-up. The polypoid duodenal subepithelial lesion, measuring about 7 mm, was removed by the endoscopic mucosal resection and the pathology confirmed a neuroendocrine tumor. Abdominopelvic computed tomography, done for staging work up, revealed a mass in the pancreatic head and the patient received pylorus preserving pancreaticoduodenectomy. Mass at the pancreas also found out to be neuroendocrine tumor but showed different histopathologic traits under immunohistochemical staining. The patient was also diagnosed as hyperparathyroidism and pituitary microadenoma. Finally, multiple endocrine neoplasia type 1 was confirmed, which was accompanied by duodenal neuroendocrine tumor.
Adult ; Antigens, CD56/metabolism ; Duodenum/*pathology ; Endoscopy, Digestive System ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Neoplasms, Multiple Primary ; Neuroendocrine Tumors/*diagnosis/metabolism/surgery ; Pancreas/*pathology ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

Gastrointestinal neuroendocrine tumors arise from cells of the diffuse neuroendocrine system and can take place almost anywhere within the gastrointestinal tract. A 40-year-old man admitted to evaluate a duodenal subepithelial lesion which was incidentally found at health check-up. The polypoid duodenal subepithelial lesion, measuring about 7 mm, was removed by the endoscopic mucosal resection and the pathology confirmed a neuroendocrine tumor. Abdominopelvic computed tomography, done for staging work up, revealed a mass in the pancreatic head and the patient received pylorus preserving pancreaticoduodenectomy. Mass at the pancreas also found out to be neuroendocrine tumor but showed different histopathologic traits under immunohistochemical staining. The patient was also diagnosed as hyperparathyroidism and pituitary microadenoma. Finally, multiple endocrine neoplasia type 1 was confirmed, which was accompanied by duodenal neuroendocrine tumor.
Adult ; Antigens, CD56/metabolism ; Duodenum/*pathology ; Endoscopy, Digestive System ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Neoplasms, Multiple Primary ; Neuroendocrine Tumors/*diagnosis/metabolism/surgery ; Pancreas/*pathology ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

BACKGROUND: We evaluated the value of neutrophil-lymphocyte count ratio (NLCR) in patients admitted to the Emergency Department (ED) with suspected nursing home acquired pneumonia (NHAP). METHODS: From May 2011 to January 2013, 116 patients admitted to the ED with suspected NHAP were retrospectively studied. The clinical characteristics, C-reactive protein (CRP), white blood cell count, neutrophil count, lymphocyte count, and NLCR were assessed. CURB-65 score was used to calculate disease severity. General ward or intensive care unit (ICU) admissions, and 72-hour and 30-day mortality for each infection marker was assessed. RESULTS: The 116 patients had a median age of 77 years. As the CURB-65 score increased from 0-1 (low risk), to 2-3 (moderate risk), and to 4-5 (high risk), the NLCR consistently increased (mean, 6.9, 8.89, and 16.22, respectively). The difference between the moderate and high risk groups was significant (p=0.008). The NLCR (mean+/-standard deviation) was high in patients with NHAP (10.28+/-8.81) and increased even more for patients admitted to the ICU (15.69+/-14.81) or who died within 72-hour (15.63+/-9.57). NLCR showed the trend of higher value in ICU admission (p=0.072), and CRP was significantly different between ICU and general ward admission (p=0.007). CONCLUSION: NLCR at ED admission correlated with NHAP severity and was comparable to the traditional infection marker. NLCR can be assessed simply and added to the assessment tools to determine the severity of pneumonia during ED admission.
C-Reactive Protein ; Emergencies ; Humans ; Intensive Care Units ; Leukocyte Count ; Lymphocyte Count ; Mortality ; Neutrophils ; Nursing Homes* ; Nursing* ; Patients' Rooms ; Pneumonia* ; Retrospective Studies

We reviewed 13 patients with testicular embryonal carcinoma from July 1982 to May 1994. Embryonal carcinoma accounted for about 25% of total testicular tumors(13/56) and about 34% of nonseminomatous germ cell tumors(13/38). Among the patients with embryonal carcinoma, about 85% were diagnosed in the 15-to-34 year age group. About seventy percent of the patients had metastatic disease at the time of diagnosis and 66.7% of these had distant metastasis including by lung, bone, retroperitoneal lymph node and cervical lymph node, attesting to the aggressiveness of embryonal carcinoma and its tendency to early hematogenous spread. Serum AFP was elevated in 10 patients(76.9%) and hCG in 6 patients(46.2%). All patients with stage I (4/13) were treated with radical orchiectomy only, and all patients with stage II(3/13) were treated with radical orchiectomy and retroperitoneal lymph node dissection(RPLND) followed by chemotherapy. Of the patients with stage III(6/13), 4 patients were treated with radical orchiectomy and chemotherapy, and 2 patients with radical orchiectomy and early chemotherapy, followed by RPLND. The pathologic findings of lymph node at the time of RPLND in stage III were 1 residual embryonal carcinoma and 1 fibrosis. In stage I and II, all patients were still alive. In stage III, 2 patients were still alive for 22 and 48 months. Among the 4 expired patients, 2 were from lung metastasis and the others from sepsis might caused by chemotherapy. These results suggest that the radical orchiectomy only with close clinical observation for stage l had a good survival, and long term survival in stage II patients treated with radical orchiectomy and RPLND followed by chemotherapy will be expected. And in stage III, if the side effects of the chemotherapy is reduced, the better survival may be obtained.
Carcinoma, Embryonal* ; Diagnosis ; Drug Therapy ; Fibrosis ; Germ Cells ; Humans ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Orchiectomy ; Sepsis ; Testis

OBJECTIVE: To study the safety and efficacy of using rectangular titanium cage(RABEA) for anterior cervical fusion, we have compared the results of fusion performed by using fibula allograft and RABEA cage. METHODS: Total of 74 patients with single level cervical discectomy were included in this study. Allogenic fibula bone graft alone was done in 38 patients and RABEA cage was inserted in 36 patients. Retrospective clinical analysis was based on review the symptoms and radiological findings on both two groups at postoperative 12 months. RESULTS: Solid fusion was achieved in 95% of patients who received rectangular titanium cage and 74% of patients who received fibula allograft. According to Odom's criteria, 92% of patients were found to have excellent or good results in the RABEA cage group and 68% of patients in allograft group. Functional outcome was assessed according to Odom's criteria and patient's postoperative satisfaction index(PSI). Better clinical outcome and solid fusion could be achieved by rectangular titanium cage fusion than allogenic fibula graft after single level anterior cervical discectomy. CONCLUSION: We believe that RABEA cage is an effective and safe cervical fusion substitute for single level cervical fusion after discectomy.
Allografts* ; Diskectomy* ; Fibula* ; Humans ; Retrospective Studies ; Titanium* ; Transplants

OBJECTIVE: "Paraclinoid" aneurysms include those aneurysms arising from the internal carotid artery between the site of emergence of the carotid artery from the roof of the cavernous sinus and the origin of the posterior communicating artery. The authors reviewed and analysed the results of surgical approaches to paraclinoid aneurysms treated with transcranial surgery and endovascular surgery. METHODS: Between January 1998 and May 1999, 14 patients were treated surgically through ipsilateral and contralateral pterional approaches, and anterior interhemispheric approach, and endovascular surgery for paraclinoid aneurysms. All transcranial approaches were performed by same surgeon. The medical records, neuroimaging studies and videotapes which had been recorded operations were reviewed retrospectively. RESULTS: Twelve patients presented with subarachnoid hemorrhage and ICH. Nine of fourteen patients had multiple aneurysms. Thirteen cases were small and one was a large aneurysm. Six patients were treated through ipsilateral approaches, six contralateral pterional approaches, one anterior interhemispheric approach and one primarily by GDC embolization. All aneurysms treated through contralateral approaches were multiple aneurysms. Neck clipping was performed in 9(69.2%) of the thirteen aneurysms, wrapping in four cases, among them three cases were followed by GDC embolization. The surgical outcomes were: Glasgow Outcome Scale(GOS) I 71.4%, GOS II 21.4% and GOS V 7.1%. CONCLUSION: The surgical approaches to paraclinoid aneurysms should be chosen after careful anatomical evaluation of aneurysm and its neighboring structures. 3D-CT angiography and/or the raw data of MR angiography were useful. This study supports the usefulness of the contralateral approach to paraclinoid aneurysm associated with multiple aneurysms, unruptured and small aneurysms whose dome projecting medially, superiorly and dorsally. The determination of contralateral approach to small and medially projecting paraclinoid aneurysm may be stressful to operator, thus we believe anterior interhemispheric approach is better alternated. Also we recommend the endovascular surgery after reinforcement of aneurym neck and dome in the case with difficulty in clipping.
Aneurysm* ; Angiography ; Arteries ; Carotid Arteries ; Carotid Artery, Internal ; Cavernous Sinus ; Humans ; Medical Records ; Neck ; Neuroimaging ; Retrospective Studies ; Subarachnoid Hemorrhage ; Videotape Recording

PURPOSE: To establish new in vitro model systems that better reflect in vivo condition, multicellular tumor spheroids(MTS) and raft culture were developed using cell lines of squamous cell carcinoma(SCCHN) of the head and neck. In these 3-dimensional systems, the expression of cell surface molecules which are important for modulation of physiology of tumor cells were studied with or without the treatment of interferon(IFN)-gamma. MATERIALS AND METHODS: Four SCCHN cell lines were used for MTS and raft culture. The effects of interferon-gamma on SCCHN cells were examined by immunohistochemistry. RESULTS: All cell lines formed MTS, but only Tu-138 showed a good stratification at the air-liquid interface in the raft culture system. Immunohistochemical studies of MTS using monoclonal antibodies revealed a strong staining for MHC class I, no staining for MHC-DR, a weak patch expression of ICAM-1 and a central strong staining for integrin a 6. Staining patterns were similar for the raft cultures except integrin a 6(intense full-thickness positivity). In both systems, IFN-gamma enhanced the expression of MHC-DR and ICAM-1. No significant change was found in the expression of MHC class I and integrin a 6. CONCLUSIONS: MTS and raft culture system were established successfully from the SCCHN cell lines. IFN-gamma can modulate the surface molecules of tumor cells in the 3-dimensional culture systems.
Antibodies, Monoclonal ; Carcinoma, Squamous Cell* ; Cell Line ; Head* ; Immunohistochemistry ; Intercellular Adhesion Molecule-1 ; Interferon-gamma ; Neck* ; Physiology

PURPOSE: As the influence of mass media increases, the general standard of attractiveness or beauty of a face also changes. The primary purpose of the study is to find out the factors of the attractive and beautiful face recognized by public. METHODS: We picked out standard model photography and operated with Adobe(R) Photoshop(R) and Monariza(R) virtual plastic surgery program. The contour of face, eye, nose, forehead, zygoma, chin and proportion of upper, middle, lower face were changed. The interview survey was conducted through structured standard photo for 310 respondents. That was utilized in the final analysis. Multiple regression analysis was executed by SPSS 12.0. It was used to deal with statistical data and all the other necessary analysis. RESULTS: According to general characteristics of the respondents, many differences were found in preferred face and facial aesthetic subunits. The younger generation preferred the lozenge and inverted triangle shape contour. The respondents over 40 of age preferred the egg shape contour. In chin and zygoma contour, the respondents at the age of 20 preferred distinctly small chin and relatively small lower face. On the other hand, the respondents over 40 of age preferred the wide zygoma relatively. In the proportion of upper, middle, lower face, 51.0% of respondents answered 1:1:1. If they want to have an aesthetic operation, they preferred protruding forehead. Also they preferred the small chin and V-shaped chin in frontal view. CONCLUSION: Many respondents preferred to have a plastic surgery for the better facial subunit. The statistical evidence from this study suggests that the harmony and balance of facial aesthetic subunits make attractive and beautiful face.
Beauty ; Chin ; Surveys and Questionnaires ; Eye ; Forehead ; Hand ; Mass Media ; Nose ; Ovum ; Photography ; Surgery, Plastic ; Zygoma

OBJECTIVE: The aim of this study is to determine the treatment strategies for spinal neurogenic tumor involving nerve root and to evaluate the outcome after resection of the root. METHODS: The retrospective review of 76 cases of spinal cord tumors, operated between 1992-2001, was done. We underwent surgery for 22 cases of spinal neurogenic tumors with somatosensoty evoked potential monitoring. Resection of the affected nerve root was necessary in 15 cases for complete removal of the tumor. In six patients of these the resected nerve root was relevant for upper or lower limb function and five patients underwent end to end anastomosis. RESULTS: There were 12 men and 10 women and the mean age was 43 years. The tumors were located most frequently in the lumbar area(7 cases, 31.8%). The most common initial symptoms were radiating pain(18 cases, 81.8%) and mean duration of presentation was 39.3 weeks. In all cases, tumor was removed totally except one case of schawannoma which is dumbbell-shaped and huge extradural extension to retroperitoneal cavity. The postoperative outcomes on discharge were improved in 16 cases(72.7%). Among 15 cases of tumor resection together with involving nerve root, 13 cases(86.7%) were improved. All the cases performed end to end neural anastomosis were inproved. CONCLUSION: The results indicate that resection of the involved nerve root usually do not produce neurological deficit and complete removal of tumor with the involved nerve root is one of the appropriate and safe procedure. Also, end to end anastomosis of resected nerve root contribute to the chance of regeneration and functional recovery.
Evoked Potentials ; Female ; Humans ; Lower Extremity ; Male ; Regeneration ; Retrospective Studies ; Spinal Cord Neoplasms

OBJECTIVE: The authors report a case of racemose neurocysticercosis presented with myelopathy and hydrocephalus. The cllinical symtoms were not relieved even after the operations with albendazole medication. METHODS: A 44 year-old man was transferred due to headache, quadriparesis and epileptic fit. Preoperative magnetic resonance image(MRI) on brain and computed tomographic cisternogram on brain and upper cervical cord showed racemose cysticercosis on vermis, medulla and upper cervical cord. Two times operations(vesicles removal and adhesiolysis on cerebrospinal fluid pathway) were done with albendazole medication(15mg/kg/day, 30 days). The clinical symtoms were not relieved. Ventriculoperitoneal(V-P) shunt procedure was done and the symtoms were improved. CONCLUSION: The cause of aggravated hydrocephalus might be inflammatory reaction of the host to acute destruction of parasites due to albendazole in the brain.
Adult ; Albendazole ; Brain ; Cerebrospinal Fluid ; Cysticercosis ; Headache ; Humans ; Hydrocephalus* ; Neurocysticercosis* ; Parasites ; Quadriplegia ; Spinal Cord Diseases*